Reimbursements

Category:

Rounding Discrepancies

Reimbursement Policy: NDRP-Misc-001
Topic: Coding
Effective Date: July 1, 2018
Last Reviewed:
March 1, 2019

Description:

The purpose of this policy to provide direction on how the Plan handles rounding discrepancies when the actual amount allowed may differ from the published fee schedule by one cent.

Policy:

In the HMHS platform, when a claims multiplier computes the allowed amount for a billed service, the allowed amount may differ from the amount calculated by taking the published fee schedule time the number of units billed.  The variance will normally be about one penny.

The variance is due to rounding, as the printed fee schedule only goes 2 spaces to the right of the decimal point; while the rate in the claims system may reflect the rate going out 3 spaces to the right of the decimal point.

Due to the immateriality of these rounding discrepancies and the costs associated with reprocessing claims for both BCBSND and the provider, BCBSND will not reprocess claims for rounding discrepancies.